Months Of Management Research Articles

Potential hip fracture early death predictors – a retrospective analysis from prospective trauma registry

Objectives: To explore the blood pressure, fracture anatomical site, and age as potential predictors of death within 3 months after proximal femoral fracture management. Method: The retrospective study was conducted from June 2015 and March 2020 at the Aga Khan University Hospital, Karachi and comprised orthopaedic trauma registry data of isolated proximal femur fracture patients managed between June 2015 and March 2020. Data of those who expired within 3 months of the management was pooled in group A, while data of those who survived >3 months post-treatment formed group B. Blood pressure at the time of hospital admission was considered normal at 90-120mmHg systolic and 60-80mmHg diastolic. Data was analysed using SPSS version 19.0. Results: Of the 242 patients, 9(3.7%) were in group A; 5(55.5%) males and 4(44.4%) females with median age 78 years (interquartile range: 7 years). There were 233(96.3%) patients in group B; 123(52.7%) females and 110(47.2%) males with median age 70 years (interquartile range: 17 years). In 12 months post-treatment, 16(6.6%) patients expired; 9(56.25%) in group A, and 7(43.75%) in group B. Age >75 years and femoral neck fractures had a significant positive relationship with death within 3 months of surgical management (p<0.05). Conclusion: Patients with femoral neck fracture and aged >75 years were found to be at the risk of death within 3 months post-management. Key Words: Proximal femur fracture, Trauma, Diastolic blood pressure, Femoral neck fracture, Death.

Case Report: “Precocious Puberty in a Child with Cortisone Reductase Type 2 Deficiency”

Cortisone reductase type 2 (CRD2) deficiency causes a failure in the regeneration of active cortisol from cortisone via the enzyme 11-beta-hydroxysteroid dehydrogenase (11β-HSD1), a deficiency that stimulates adrenal hyperandrogenism mediated by the increase in adrenocorticotropin (ACTH) causing peripheral precocious puberty in males. We present the first case in our setting of a 5-year-old boy carrying a rare pathogenic variant in 11β-HSD1 gene, who due to prolonged exposure to adrenal androgens developed central precocious puberty (CPP). We describe his evolution after 36 months of management, adding to the very small number of patients reported in the world, and drawing attention to the importance of an early diagnosis.

The Effectiveness of Some Chronic Pulmonary Management Units for Patients with COPD and Asthma in Vietnam

Introduction: Asthma and chronic obstructive pulmonary diseases are chronic diseases and have high mortality rates in Vietnam and other countries. The chronic pulmonary disease Management Unit is a management model connecting inpatient and outpatient treatment for asthma and COPD patients. Patients receive long-term management and full consultation to share experiences and be provided with necessary information about the disease. The main purpose was to evaluate the effectiveness of the unit for patients with COPD and asthma in Vietnam. Material and Methods: A Combined cross-sectional study and retrospective longitudinal study were conducted on 310 COPD and asthma patients at Hai Duong, Bac Giang, Thai Nguyen. The questionnaires included 30 questions with two sections including sociodemographic data and using management and treatment services. Results: After 24 months of management and treatment, knowledge of the disease, medicine use, symptoms, range of activities, eating, sleeping status, and disease control of patients were improved better. For ACT score, the points increased by 2.1 points, 3.4 points, and 4 points, respectively. For the CAT score, the point reduced by 3.7 points, 6.4 points, and 9.1 points, respectively. Improved severe breathlessness efficiency index from 0.6% at 6 months to 9.5% after 24 months. Conclusion: Our findings suggest that the government needs to invest in facilities, equipment, and human resources to maintain and replicate the model nationwide to help patients receive timely management and treatment, contributing to reducing treatment costs and improving the quality of life for asthma and COPD patients.

The Effect of Renastart Formula Supplementation in Serum Electrolytes in Children with Acute Kidney Injury

Abstract Background patients of renal disease suffer from electrolyte disturbances including hyperkalemia, hyperphosphatemia, hyponatremia, hypocalcemia and hypermagnesemia. Unfortunately, patients with kidney disease require close monitoring for serum electrolytes to maintain normal levels; with traditional nutritional interventions they may need receiving potassium and phosphorus binders Aim: This study will concentrate on the effect and tolerability of Renastart formula supplementation on correction and maintaining serum levels of electrolytes in AKI or AKI on top of CKD pediatric patients. Methods Double arm clinical convenient trial, conducted in Pediatric Nephrology Unit,Ain Shams University, Cairo, Egypt, where 24 participants who had AKI or AKI on top of CKD with hyperphosphatemia and / or hyperkalemia were recruited, the mean of age of participants was 4.1±3.15 years ranged from 0.5 to 10 years. Subjects were divided into two groups, 12 patients per group (group A received a calcium carbonate (phosphorus binder) (9 patients) with dosage 45-65 mg/kg/day orally alone or withsodium polystyrene sulfonate (potassium binder) (11 patients) with dosage 0.5-1mg/kg/day oral and group B received Renastart formula supplemented with breast milk, standard infant formula or diet), the dosage ratio was adjusted to be 1:3 (Renastart was 1/4 daily caloric intake) if serum potassium level ≥5.5 - <6 meq/L and / or serum phosphorus > 7mg/dl. But, if potassium level was ≥ 6 meq/L, the ratio was 1:1 (Renastart was ½ daily caloric intake). Readjusting dosage ratio was according to serum electrolyte levels response for treatment. Follow up of serum levels of potassium was every day until its serum level returned to normal then every month for three months and serum phosphorus was every month for three consecutive months. Results All the included subjects in both groups had high serum potassium (> 5.5 meq/L) and / or high serum phosphorus (>7 mg/dl) upon enrollment, mean serum potassium and serum phosphorus were (5.7±0.41 meq/L) (7.2±1.6 mg/dl) respectively. Regarding the decrease of serum potassium, Renastart formula supplementation in group B and potassium binders in group A resulted in equal decrease in serum potassium levels; Potassium after 3 months of management in group B was (4.22±0.28 mEq/L) (p value between 3rd month- baseline month in group B p < 0.01) and potassium binders in group A (4.48±0.27 mEq/L) (p value between 3rd month – baseline month in group A p < 0.01). Renastart formula in group B ((potassium after 1 month of management = 4.7±0.32 meq/L) (p value between 1st month – baseline month in group B p < 0.01)) had more rapid effect than potassium binders in group A during 1st month of the study ((potassium after 1 month of management =5.1±0.41 meq/L) (p value between 1st month – baseline month in group A p > 0.05). Regarding decrease in serum phosphorus, Renastart formula supplementation in group B resulted in more decrease in serum phosphorus levels though both showed significant drop in phosphorus level (( serum phosphorus after 3 months of management = 4.60±0.29 mg/dl (p value between 3rd month – baseline month in group B p = 0.002)) in comparison to that achieved by phosphorus binders in group A ((5.21±0.29mg/dl) (p value between 3rd month – baseline month in group A p = 0.01)), moreover Renastart supplementation in group B was more rapid than phosphorus binders in group A in decrease serum phosphorus (p value between 1st month and baseline in group B p = 0.002) (p value between 1st month and baseline in group A p = 0.17) Conclusion We can conclude that Renastart formula supplementation was more rapid than potassium binders in decreasing serum potassium levels in AKI pediatric patients, moreover more effective and rapid than phosphorus binders in decreasing serum phosphorus.

The Effectiveness of Electronic Cannulation Atlas in Patients with Arteriovenous Fistula.

This study aimed to assess the effectiveness of an electronic cannulation atlas in preventing and treating complications of arteriovenous fistula. The observation group, consisting of 92 dialysis patients from July to December 2021, was managed with an electronic cannulation atlas. After 6 months, the incidence of complications such as stenosis, hematoma, thrombus, aneurysm, and cannulation failure was compared between the groups. Nurse satisfaction with the electronic cannulation atlas system was also assessed through a questionnaire. The observation group had lower incidence rates of arteriovenous fistula stenosis, thrombus, aneurysm, and failure rate of cannulation compared to the control group, with statistically significant differences (p<0.05). The incidence rates of hematoa were similar in both groups, showing no significant difference (p>0.05). After 3 months of management, the incidence of arteriovenous fistula complications in the observation group was significantly lower than in the control group (p<0.05). Additionally, utilizing the electronic cannulation atlas system was found to increase nurses' job satisfaction. The use of electronic cannulation atlas for the treatment of patients' arteriovenous fistula could effectively reduce the incidence of complications of patients' arteriovenous fistula, reduce the failure rate of cannulation, reduce the workload of nurses, and improve the job satisfaction of nurses.

Effective management of ulcerative colitis with Udumbara kwatha and Udumbara kwatha basti: A single case report

Ulcerative Colitis (UC) is an idiopathic, chronic inflammatory disorder of the colonic mucosa with remitting and relapsing pattern that usually involves the rectum and extends proximally to involve the sigmoid part of the colon (proctosigmoiditis) or whole colon (pancolitis). The cardinal symptoms are rectal bleeding with the passage of mucus and bloody diarrhea. In modern medical science, there is no permanent curative and safe treatment for this disease. A 32-year-old male, advocate by profession, diagnosed with UC for the past six years, presented to the hospital with complaints of frequent stools mixed with blood and mucous associated with abdominal pain. The condition was managed with Udumbara kwatha basti (~therapeutic enema with Udumbara decoction) and other Shamana aushadha (~palliative medicines). After one month of management, the stool frequency was reduced, and after a follow-up of one-year, normal consistency of stools was attained. This case report illustrates the significance of ayurvedic treatment modalities in the management of UC, generating hypothesis for further research.

Effect of Shunthi dhanyaka sadhita jala and lifestyle modifications in the management of Prameha purvarupa (prediabetes): An observation

In prediabetes, the blood glucose levels are higher than normal but not enough to qualify as diabetes. The prevalence of prediabetes in India is 14%. Prevention of prediabetes would prevent life-threatening consequences. Prameha purvarupa (~prodromal symptoms of diabetes mellitus) in Ayurveda correlates clinically to the features of prediabetes. Prameha purvarupa is a Santarpanottha (~sedentary lifestyle related) and Meda pradoshaja vikara (~disorder of adipose tissue) that typically manifests in individuals who are Chankramana dveshi (~aversion to walking) and is brought on by vitiated Doshas (~regulatory functional factors of the body) and Dushyas (~which gets vitiated by aggravated Doshas). Elevation of blood glucose level in prediabetes may be considered retention of Ama (~metabolic toxins) in the body. A 38-year-old prediabetic female, unable to lose weight after several attempts, was managed for three months with Shunthi dhanyaka sadhita jala (~water processed with dry ginger, and coriander). In addition, she was also suggested Chankramana (~brisk walking) during the early hours of the day and Swabhavika nidra (~regular and natural sleep). Improvement in glycosylated hemoglobin, and disappearance of Prameha purvarupa such as Karapada tala daha (~burning sensation of palms and soles), Madhura asyata (~sweet taste in mouth), and weight loss after three months of management. The case report depicts the effectiveness of a simple, practical, and affordable Ayurvedic treatment approach in the management of prediabetic conditions.

Clinical Application of Cardiac Rehabilitation Program Based on Self-efficacy Theory in Patients with Acute Myocardial Infarction Undergoing Percutaneous Transluminal Coronary Intervention

Objective: This study aimed to evaluate the effectiveness of a cardiac rehabilitation program based on self-efficacy theory in patients with acute myocardial infarction (AMI) undergoing percutaneous transluminal coronary intervention (PCI). Methods: A retrospective analysis was conducted on the medical records of 417 patients with AMI who underwent PCI at our hospital from May 2020 to May 2022. Patients were categorized into a control group (210 patients following a cardiac rehabilitation program) and an observation group (207 patients following a cardiac rehabilitation scheme based on self-efficacy theory). Data on demographics, diseases, and 1-year follow-up information were collected from the participants. Comparisons between the groups were made in terms of left ventricular ejection fraction (LVEF), six-minute walk distance test (6MWD), hospitalization duration, the 36-item short-form health survey (SF-36) score, and the incidence of angina pectoris and AMI recurrence within one-year post-management. Results: Initially, the groups had no significant difference in LVEF and 6MWD (p &gt; 0.05). However, after 1 and 3 months of management, the observation group exhibited higher LVEF and 6MWD than the control group (p &lt; 0.001). The observation group had a significantly shorter hospitalization duration (p &lt; 0.001) and higher SF-36 scores post-management (p &lt; 0.001). Furthermore, the incidence of angina pectoris and AMI recurrence within a year post-management was lower in the observation group (p &lt; 0.05). Conclusion: The cardiac rehabilitation program grounded in self-efficacy theory significantly improves cardiac function in patients with AMI, accelerates their post-PCI rehabilitation, improves quality of life, and reduces the recurrence of angina pectoris and AMI. This approach offers new directions for cardiac rehabilitation management of AMI.

The Effectiveness of Some Chronic Pulmonary Management Units for Patients With COPD and Asthma in Vietnam

Background: Asthma and chronic obstructive pulmonary diseases are chronic diseases and have high mortality rates in Vietnam and other countries. Chronic pulmonary disease Management Unit is a management model connecting inpatient and outpatient treatment for asthma and COPD patients. Patients receive long-term management and full consultation to share experiences and be provided with necessary information about the disease. Objective: The main purpose was to evaluate the effectiveness of the unit for patients with COPD and asthma in Vietnam. Methods: A Combined cross-sectional study and retrospective longitudinal study was conducted in 310 COPD and asthma patients at Hai Duong, Bac Giang, Thai Nguyen. The questionnaires included 30 questions with two sections including sociodemographic data and using management and treatment services. Results: After 24 months of management and treatment, knowledge of the disease, medicine use, symptoms, range of activities, eating, sleeping status, and disease control of patients were improved better. For ACT score, the points increased by 2.1 points, 3.4 points, and 4 points, respectively. For the CAT score, the point reduced by 3.7 points, 6.4 points, and 9.1 points, respectively. Improved severe breathlessness efficiency index from 0.6% at 6 months to 9.5% after 24 months. Conclusion: Our findings suggest that the government need to invest in facilities, equipment, and human resources to maintain and replicate the CMU to help patients receive timely management and treatment, contributing to reducing treatment costs and improving quality of life for asthma and COPD patients.

Incidence of cervical spine injuries in paediatric patients and their outcome in tertiary care hospital

Objective: The incidence of mortality after cervical trauma in the pediatric population is very high. The purpose of this study was to determine the treatment given, morbidity and mortality of patients with cervical spine injuries, and their outcome after 6 months of management which includes both surgical and conservative treatment. Materials &amp; Methods: A prospective study was conducted at Lady Reading Hospital, Peshawar with a total number of patients n = 187 included in our study. Patients were stratified according to their age, mortality, mechanism of injury (fall, motor vehicle accident, bicycle injuries, &amp;sports-related injuries), level of cervical spine injury, presence of neurologic deficit, presence of bony injury (fractures, &amp;dislocations), ligamentous injuries &amp; SCIWORA. The primary outcome was the functional status at 6 months following treatment. Results: There were 78 females and 109 males. In comparison to the lower cervical spine (C3 – C7), which was involved in 86 patients (46%), the higher cervical spine level (C0 – C2) was involved in 101 patients (or 54%). The most frequent cause of cervical spine injuries in the older age range was a history of a fall, followed by a motor vehicle accident. Among the treatment groups, mortality was highest in patients who underwent surgery. Conclusion: Younger age groups, higher cervical spine levels, and mechanisms of injury such as high energy impact trauma were independent risk factors for increased mortality. Compared to incomplete neurological abnormalities, a complete neurological disability increases mortality.

Guillain Barre Syndrome following Electrical Burn Injury: A Case Report

GuiIlain-Barre syndrome is an idiopathic acute or subacute inflammatory demyelinating polyneuropathy withascending and often bilaterally symmetrical paralysis. The diagnosis is made on the basis of clinical presentationwhich is mostly acute flaccid paralysis, and electrochemical analysis. We present a case of electrical burn injuryfollowed by GB Syndrome like features. Patient received the standard treatment of GB Syndrome that is I/Vimmunoglobulins and physiotherapy besides ventilatory support and supportive treatment of electrolyte andfluid management. He was discharged satisfactorily after two months of management in the hospital

The Influence of PDCA Process Management on the Incidence of Stab Wound and Psychological Anxiety of Nursing Interns.

Objective To research the influence of PDCA (Plan-Do-Check-Act) process management on the incidence of needle injury and psychological anxiety of nursing interns. Methods This study belonged to the experimental study. A total of 180 nursing interns who practiced in the hospital from March 2020 to April 2022 were studied. A total of 135 interns from March 2020 to March 2021 were selected as the control group and 175 interns from April 2021 to April 2022 as the research group. PDCA process management was carried on in the research group. The control group did not make any intervention only following the routine teaching plan. The incidence of needle injury, theoretical knowledge, behavior score, self-rating anxiety scale (SAS), professional self-efficacy questionnaire score, and nursing practice satisfaction score were evaluated before and after 12 months of management. Results After management, the incidence of needle injury in the research group was lower compared to that in the control group, and there are statistically significant differences between groups (P < 0.05). The scores of theoretical knowledge, attitude, and behavior in the research group were higher compared to those in the control group, and there are statistically significant differences between groups (P < 0.05) after management. After 12 months of management, the SAS score of the research group was lower compared to that of the control group, and there are statistically significant differences between groups (P < 0.05). The score of occupational self-efficacy questionnaire in the research group was higher compared to that in the control group, and there are statistically significant differences between groups (P < 0.05) after PDCA process management. After 12 months of management, the satisfaction score of nursing practice in the research group was higher compared to that in the control group, and there are statistically significant differences between groups (P < 0.05). Conclusion Through PDCA process management, we can keep abreast of the situation of needlestick injuries among nursing students in practice and analyze in more detail the root cause of each nursing student's occupational exposure and the outcome of treatment. The nursing students not only learn more practical knowledge in clinical practice but also feel that the hospital values and cares for them, which greatly increases their satisfaction.

Reversal of Diabesity: Normalization of Insulin Release Curve in Association with Reversal of Non-Alcoholic Fatty Liver Disease

Objective: Type 2 diabetes with obesity is regarded as an incurable, progressive disease with many complications. The hypothesis was tested that glycated haemoglobin (HbA1c) and the insulin release curve can be restored by traceable systematic methods. Methods: 122 people with diabesity were investigated before and after three and 6 months of traceable systematic management methods. Basal body mass index (BMI), fatty liver, HbA1c, and insulin release curve were measured. Results: After 3 months of traceable systematic management, BMI decreased from 30.76 ± 0.48 to 21.86 ± 0.09 kg/m2 (p < 0.001) and remained stable during the last 3 months (21.82 ± 0.09 kg/m2 at 6 months). Colour Doppler ultrasound showed non-alcoholic fatty liver disease (NAFLD) in all diabesity participants at baseline. At 3 months, only one participant had low-grade fatty liver, and fatty liver was reversed in other participants (p < 0.001). The number and grade of fatty liver at 6 months were the same as at 3 months. Fasting plasma glucose decreased and continued to decrease thereafter (p < 0.001). Two-hour postprandial plasma glucose decreased and continued to decline until 6 months (p < 0.001). HbA1c also decreased and maintained this level at 6 months. At baseline, the peak value of insulin release was 1,141.09 ± 43.02 pmol/L at 2 h after meals, and the early phase of insulin secretion was lost. After 3 months of management, the insulin concentration was 621.62 ± 19.32 pmol/L at 2 h after meals. After 6 months, the value decreased, and the early phase of insulin secretion recovered. Conclusions: Normalization of the insulin release curve in type 2 diabetes was achieved by traceable systematic methods. This was associated with recovery from NAFLD. Diabesity is reversible by traceable systematic management.

Relationship between Progressive Cup Disc Ratio and Intraocular Pressure in Primary Open Angle Glaucoma After 2 Antiglaucoma Agents for 3 Months

Introduction: Primary open-angle glaucoma (POAG) is a subset of glaucoma defined by an open, normal-appearing anterior chamber angle and raised intraocular pressure (IOP) with no other underlying disease. Globally 57.5 million people were affected by primary open-angle glaucoma (POAG) in 2015, rising to 65.5 million by 2020. POAG can further lead to optic nerve damage, which can cause total blindness. POAG cannot be cured but can be controlled with medical therapy, laser, and surgical procedures. Antiglaucoma drugs are a method of treatment that can overcome this disease. This study aims to determine the characteristics of patients with POAG and progressivity of cup to disc ratio and intraocular pressure after 3 months of management of 2 antiglaucoma agents in POAG patients in Dr. Mohammad Hoesin General Hospital Palembang.&#x0D; Methods: This study retrospectively reviewed the medical records specific to primary open-angle glaucoma. Data was obtained from the patient register book recorded from February 2022 to May 2022 in Dr. Mohammad Hoesin General Hospital Palembang. The parameters analyzed were patients' profiles, namely gender, intraocular pressure, and cup to disc ratio before and after 3 months of combination 2 antiglaucoma agents. Timolol and latanoprost are the 2 antiglaucoma agents given to patients diagnosed of previous POAG (by an ophthalmologist).&#x0D; Results: From 30 patients diagnosed with POAG by an ophthalmologist, the number of primary open-angle glaucoma patients was more female, namely 19 patients (63.3%) than 11 male patients (36.7%), with a ratio of 1.28:1 between women and men. The cup to disc ratio between before and after 3 months of therapy using timolol and latanoprost was 0.628 ± 0.04 before therapy to 0.645 ± 0.06 after therapy (p&lt;0.05). Intraocular pressure before and after 3 months of therapy was 24.76 ± 2.63 before therapy to 17.75 ± 2.08 (p&lt;0,05). Both cup to disc ratio and intraocular pressure differs statistically from before and after therapy.&#x0D; Conclusion: Fixed combination therapy of timolol and latanoprost is effective in lowering intraocular pressure and reducing cup to disc ratio progressivity in patients with primary open-angle glaucoma.

Intérêt diagnostique de la TEP-TDM au 18F-FDG dans le diagnostic d’endocardite infectieuse sur valve native

BackgroundNative valve endocarditis (NVE) is a rare but serious disease. The prognosis depends on the rapidity of diagnosis, and is currently based on modified Duke criteria, where echocardiography has a key role but may lack sensitivity if valves are calcified. For prosthetic valves, the European Society of Cardiology 2015 recommendations added 18F-FDG PET/CT as a major imaging criterion as well as for extension assessment. This study evaluated the diagnostic accuracy of 18F-FDG PET/CT in NVE and in extension assessment. MethodsThis retrospective study involved 59 patients suspected of NVE at Bordeaux university hospital between 2011 and 2019 and received 18F-FDG PET/CT. The final diagnosis was established according to Duke criteria after 3 months of management. Infective endocarditis (IE) was assessed in the initial phase according to the Duke criteria. All PET/CTs were blindly reviewed jointly by a junior and senior nuclear-medicine physician. ResultsIn total, 59 patients were included. At 3 months, 26 patients had definite IE, 22 had rejected IE, and 11 possible IE. Twelve patients had positive PET/CT results. The sensitivity of the modified Duke criteria in the initial phase was 77% and the specificity was 81%. When combined with 18F-FDG PET/CT, the sensitivity of the Duke criteria increased to 96% and the specificity was 81%. The sensitivity of 18F-FDG PET/CT alone was 46%. All three patients with perivalvular abscess had positive PET/CT results. Of the 22 patients with NVE definite at 3 months, fourteen (54%) had at least one septic embolism diagnosed on PET/CT. ConclusionsThe implementation of 18F-FDG PET/CT with modified Duke criteria increased the sensitivity for NVE diagnosis in the initial phase and contributed to IE extension assessment. It may contribute to making the diagnosis of a local cardiac complication.

Mortality Risk Prediction Dynamics After Heart Failure Treatment Optimization: Repeat Risk Assessment Using Online Risk Calculators.

ObjectivesHeart failure (HF) management has significantly improved over the past two decades, leading to better survival. This study aimed to assess changes in predicted mortality risk after 12 months of management in a multidisciplinary HF clinic.Materials and MethodsOut of 1,032 consecutive HF outpatients admitted from March-2012 to November-2018, 357 completed the 12-months follow-up and had N-terminal pro-B-type natriuretic peptide (NTproBNP), high sensitivity troponin T (hs-TnT), and interleukin-1 receptor-like-1 (known as ST2) measurements available both at baseline and follow-up. Three contemporary risk scores were used: MAGGIC-HF, Seattle HF Model (SHFM), and the Barcelona Bio-HF (BCN Bio-HF) calculator, which incorporates the three above mentioned biomarkers. The predicted risk of all-cause death at 1 and 3 years was calculated at baseline and re-evaluated after 12 months.ResultsA significant decline in predicted 1-and 3-year mortality risk was observed at 12 months: MAGGIC ~16%, SHFM ~22% and BCN Bio-HF ~15%. In the HF with reduced ejection fraction (HFrEF) subgroup guideline-directed medical therapy led to a complete normalization of left ventricular ejection fraction (≥50%) in almost a third of the patients and to a partial normalization (41–49%) in 30% of them. Repeated risk assessment after 12 months with SHFM and BCN Bio-HF provided adequate discrimination for all-cause 3-year mortality (C-Index: MAGGIC-HF 0.762, SHFM 0.781 and BCN Bio-HF 0.791).ConclusionMortality risk declines in patients with HF managed for 12 months in a multidisciplinary HF clinic. Repeating the mortality risk assessment after optimizing the HF treatment is recommended, particularly in the HFrEF subgroup.

Pycnogenol® Supplementation Prevents Recurrent Urinary Tract Infections/Inflammation and Interstitial Cystitis.

This open pilot registry study aimed to evaluate and compare the prophylactic effects of Pycnogenol® or cranberry extract in subjects with previous, recurrent urinary tract infections (UTI) or interstitial cystitis (IC). Methods. Inclusion criteria were recurrent UTI or IC. One subject group was supplemented with 150 mg/day Pycnogenol®, another with 400 mg/day cranberry extract, and a group served as a control in a 2-month open follow-up. Results. 64 subjects with recurrent UTI/IC completed the study. The 3 groups of subjects were comparable at baseline. All subjects had significant symptoms (minor pain, stranguria, repeated need for urination, and lower, anterior abdominal pain) at inclusion. In the course of the study, the subjects reported no tolerability problems or side effects. The incidence of UTI symptoms, in comparison with the period before inclusion in the standard management (SM) group, decreased significantly; there was a more pronounced decrease in the rate of recurrent infections in the Pycnogenol® group (p < 0.05). The improvement in patients supplemented with Pycnogenol® was significantly superior to the effects of cranberry. At the end of the study, all subjects in the Pycnogenol® group were infection-free (p < 0.05vs. cranberry). Significantly, more subjects were completely symptom-free after 2 months of management with Pycnogenol® (20/22) than with SM (18/22) and cranberry (16/20). Conclusions. This pilot registry suggests that 60 days of Pycnogenol® supplementation possibly decrease the occurrence of UTIs and IC without side effects and with an efficacy superior to cranberry.

SUSTAINABLE CITY DEVELOPMENT: A BRAZILIAN GOAL PLAN IN PRACTICE

By 2050, two-thirds of all humanity will live in urban areas; as a result, sustainable development will become fundamental for the management of cities. Making cities sustainable means creating opportunities, safe and affordable housing, and building economic and resilient societies. To achieve sustainable development, it is crucial to harmonize three core elements: economic growth, social inclusion, and environmental protection. These components are intertwined and fundamental to the well-being of individuals and societies. This research portrays the Municipal Goals Plan as a strategy foreseen in the Sustainable Cities Program, in view of the United Nations Conference on Sustainable Development, held in Brazil in 2012 and known as Rio +20. The study has a descriptive exploratory character, the use of a case study of the municipality of Antônio Prado, located in southern Brazil, was chosen as a technical procedure testing, and describes how a small municipality could develop and apply the Municipal Goals Plan, based on the objectives of sustainable development(SDG). The results displayed in 42 months of Management (2017-2020) were very satisfactory and actually reached 90% of the 97 actions foreseen by the work teams and this mostly due to three factors: 1) the engagement of those responsible for Administrative Management; 2) the importance of planning, at both strategic and operational levels; and 3) the commitment of the teams in the execution of the actions. These three key factors for the success of the plan triggered an effective collaborative construction work, which may be called collaborative governance.

Crisis and Intergovernmental Retrenchment in the European Union? Framing the EU\u2019s Answer to the COVID-19 Pandemic

The outbreak of the COVID-19 pandemic has placed severe pressure on the EU’s capacity to provide a timely and coordinated response capable of curbing the pandemic’s disastrous economic and social effects on EU member states. In this situation, the supranational institutions and their models of action are evidently under pressure, seeming incapable of leading the EU out of the stormy waters of the present crisis. The article frames the first months of management of the COVID-19 crisis at EU level as characterised by the limited increase in the level of steering capacity by supranational institutions, due to the reaffirmed centrality of the intergovernmental option. To explain this situation, the article considers the absence of the institutional capacity/legitimacy to extract resources from society(ies), and the subsequent impossibility of guaranteeing an effective and autonomous process of political (re)distribution, the key factors accounting for the weakness of vertical political integration in the response to the COVID-19 challenge. This explains why during the COVID-19 crisis as well, the pattern followed by the EU is rather similar to past patterns, thus confirming that this has fed retrenchment aimed at the enforcement of the intergovernmental model and the defence of the most sensitive core state powers against inference from supranational EU institutions.

Policy design and state capacity in the COVID-19 emergency in Italy: if you are not prepared for the (un)expected, you can be only what you already are

ABSTRACT Italy was the first large epicentre of the COVID-19 pandemic in the Western world. Since the country has not had any serious experience with this kind of disease in recent decades, its response has been indicative of a first reaction to an (un)known and (un)expected event. At the same time, the Italian experience is an emblematic case of how a lack of specific preparedness measures drives a country to deal with this kind of crisis through a process in which the existing characteristics of the policy and political system, with all their pros and cons, prevail. This means that the existing country characteristics that affects policy design, state capacity, institutional arrangements and political games forge the process and content of the response. Based on this observation, this paper analyses the policy dynamics of the first four months of management of the COVID-19 outbreak in Italy, focusing on how the health and economic responses were designed and implemented.